]]>http://www.saturdayeveningpost.com/2016/04/13/humor/cartoons-humor/cartoons-staying-shape.html/feed0Ads You’ll Never See Again: The Way We Atehttp://www.saturdayeveningpost.com/2016/01/21/archives/advertisements-archives/ads-youll-never-see-again-foods-your-parents-ate.html
http://www.saturdayeveningpost.com/2016/01/21/archives/advertisements-archives/ads-youll-never-see-again-foods-your-parents-ate.html#commentsThu, 21 Jan 2016 14:00:37 +0000http://www.saturdayeveningpost.com/?p=113488Based on these vintage food ads from The Saturday Evening Post, Americans’ buying habits and health priorities have changed a lot, and for the better.

To judge from this sampling, food ads often focused less on the products themselves and more on happy family members. Advertisers appealed to the consumer — a (presumably) female homemaker — through images of well-fed kids and gratified husbands.

And some of these ads … well, we can’t even imagine what the advertiser was thinking.

Stuffed

Kellogg’s advertisementThe Saturday Evening PostJuly 18, 1914

Judging from this ad, mothers of 1914 didn’t worry too much about childhood obesity.

Fully Nutritious

Americans began using margarine during World War II, when rationing reduced the availability of butter. However, margarine in its natural state had a white, lard-like color. Dairy farmers succeeded in getting laws passed that prohibited margarine makers from dyeing their product an appetizing, buttery yellow. Eventually, these laws were set aside, and margarine makers could promote their product in a natural “sunny color.”

My Feet

Cute baby photos were popular among advertisers in the 1950s. They appeared in ads for all sorts of products, including cigarettes. While the photo in this ad was the work of “the one and only Constance Bannister, America’s foremost baby photographer,” it’s hard to see how it sold “skinless” hot dogs.

Wife Beaters

“Women everywhere are cheerfully admitting that Campbell’s beat them at soup making.” Why? What did you think they meant?

“Got a good man? Keep him happy.”

Acme Coffee advertisementThe Saturday Evening PostFebruary 2, 1963

The small print in the upper corner explained that the very ’60s-looking “wife pleasing” cup and saucer were sold at Acme, back in the days when supermarkets competed by selling place settings, cookware, and encyclopedias.

No Time To Be Frail

Lastly, we offer this wartime bulletin to homemakers: “The dainty days are done for the duration.” Whether you were a housewife or a riveter, World War II was “no time to go easy on such basic food as bread,” according to the makers of Fleischmann’s Yeast. Just three slices would give you enough energy to do an hour’s housework. Four slices would power 30 minutes of wood chopping. Bread would help us win the war.

Coming Soon from The Saturday Evening Post: Ads You’ll Never See Again

A special collector’s edition of The Saturday Evening Post filled with ads from the past that will delight, entertain — and sometimes shock — with images and concepts that are thoroughly inappropriate today. You’ll cringe when you see babies wrapped in then-brand-new cellophane. You’ll laugh out loud at Santa promoting a cigarette brand. You’ll wince at an ad that threatens housewives with a spanking for failing to complete their domestic chores. More than just an entertainment, the special issue offers a snapshot of attitudes about gender, childrearing, and marketing in an era that most readers will remember all too well.

It’s too early to order, but if you might be interested in purchasing this product, please click here and we’ll send you a notice when the special issue is available.

]]>Many people with arthritis swore by Celebrex, Vioxx, and similar long-lasting prescription NSAIDs (nonsteroidal anti-inflammatory drugs) in the late 1990s through early 2000s. Then came a big pullback when research linked these pills to heart attacks and strokes. Vioxx was pulled from the market because of its greater risk. But many swore off Celebrex, too. Now Celebrex is regaining popularity and so is Mobic. We asked Kate Lapane, Ph.D, an epidemiologist at University of Massachusetts, and rheumatologist Dr. Allan Gibofsky at Hospital for Special Surgery in New York, what people need to know before starting.

1. Risk is relative. All NSAIDs, whether prescription or over-the-counter, carry some risk, but the dangers for any individual have to do with your current heart health. “We are now more attuned to NSAID risk and can better balance it with the risk of under-treating joint pain,” Gibofsky says.

2. Dosage is a key factor. When nonprescription NSAIDs such as ibuprofen, naproxen, and aspirin are no longer working, or when you find yourself taking them at higher than recommended doses, it may be time to switch to a prescription.

3. It’s a team effort. When you take NSAIDs in prescription form, there’s the benefit of having expert supervision. “Taking them under a physician’s care is safer than self-treating pain from a progressive condition,” Gibofsky says.

4. We know more today than we did then. Many ask: How do unsafe drugs get on the market? “Drug studies are designed to prove efficacy, and are often not able to detect safety issues,” Lapane explains. “These studies are not large enough to detect side effects — that takes hundreds of thousands of people and sometimes years of follow-up.” She says NSAIDs on the market today have stood the test of time, but it bears repeating that none are risk free.

]]>http://www.saturdayeveningpost.com/2015/10/13/in-the-magazine/health-in-the-magazine/rx-arthritis-pills-are-they-safe.html/feed16 Megatrends in Healthcarehttp://www.saturdayeveningpost.com/2015/08/31/in-the-magazine/health-in-the-magazine/6-megatrends-healthcare.html
http://www.saturdayeveningpost.com/2015/08/31/in-the-magazine/health-in-the-magazine/6-megatrends-healthcare.html#respondWed, 30 Nov -0001 00:00:00 +0000http://www.saturdayeveningpost.com/?p=110550One of the architects of Obamacare explains why he believes the law will revolutionize the American medical system.

]]>When it was first enacted, the Affordable Care Act (ACA, “Obamacare”) was a political disaster for President Obama and the Democrats. It produced a strident conservative backlash, which, in 2010, led to one of the largest electoral landslides in recent memory. And, until the ACA was affirmed by the Supreme Court this past June, it left the Obama administration in a perpetually defensive stance, deprived of the political capital needed to achieve progress in other important policy areas.

But regardless of these short-term political costs, in the longer sweep of history, beginning in 2020 or so, the ACA will increasingly be seen as a world historical achievement, even more important for the United States than Social Security and Medicare had been.

The ACA is stimulating a transformation of the entire American healthcare system — that is 18 percent of the economy. Before the ACA, the American healthcare system was literally killing the country. Government estimates were that the population of uninsured Americans would rise from 45 million in 2009 to 54 million in 2019. More abstract but worrisome was the impact of healthcare costs on the United States’ long-term fiscal stability. If nothing was done, Medicare and Medicaid would drown the country in a bowl of red ink.

But something was done, and that was the ACA. Although it’s far from perfect, it has stimulated change in a way nothing had been before. And these changes are just beginning.

I predict that the Affordable Care Act will create new institutions, such as the insurance exchanges, and establish new ground rules for many activities as well as for the key players in the system — insurers, hospitals, physicians, employers — and ultimately the public will respond to these new ways of delivering healthcare and conducting business.

Although everyone knows that making predictions is risky, with a knowledge of the history of the system, a knowledge of the various actors’ previous responses to change, and after discussions with hundreds of current actors, I will offer some thoughts about six megatrends for the future of healthcare. I recognize the challenges — and high probability of error — in making such forecasts. Nevertheless, such predictions are necessary to inform current decisions.

1. The End of Insurance Companies as We Know Them

Everyone hates insurance companies (for valid and sometimes not-so-valid reasons). But the good news is you won’t have insurance companies to kick around much longer. The system is changing. As a result, insurance companies as they are now will be going away. Indeed, they are already evolving.

A major initiative in the ACA for this evolution is through accountable care organizations (ACOs), which are networks of physicians or physicians, hospitals, and other providers that take both clinical and financial responsibility for the care of patients. These ACOs and hospital systems will begin competing directly in the exchanges and for exclusive contracts with employers. This health delivery structure is in its infancy. Today there are hundreds of these organizations being created and gaining experience within government-sponsored programs or getting contracts from private insurers. They are developing and testing ways to coordinate, standardize, and provide care more efficiently and at consistently higher quality standards. Over the next decade many of these ACOs and hospital systems will succeed at integrating all the components of care and provide efficient, coordinated care. They will have figured out how to harness their electronic medical records to better identify patients who will become sick and how to intervene early as well as how to care for the well-identified chronically ill so as to reduce costs. Then they will cut out the insurance company middle man — and keep the insurance company profits for themselves.

2. VIP Care for the Chronically and Mentally Ill

Today about 10 percent of patients account for nearly two-thirds of all healthcare spending. To control costs and improve the quality of care, physicians and hospitals need to focus on this small fraction of patients because they account for most of the money spent in healthcare. Who are they? They are patients with chronic or multiple chronic conditions, such as heart failure, emphysema, diabetes, coronary artery disease, asthma, hypertension, and cancer.

A key to controlling costs — and improving quality of care — is prevention. Not the kind of prevention most of us think about, such as cancer screening tests or immunizations. That is primary prevention — preventive services for healthy people who do not have diseases. Instead, what is needed is tertiary prevention, or preventing people with serious illnesses from having an exacerbation of their condition or side effects of treatment that require hospitalizations or other expensive interventions. Avoiding these kinds of repeat emergency room visits and hospitalizations for preventable problems is a major area for cost control. In other words, the key to cost control and quality improvement is to keep sick patients with chronic illnesses healthy — or at least healthier. Ensure that they are managed well so that they do not have the exacerbations or amputations or that they are treated to mitigate predictable side effects.

Today, the best healthcare systems are focusing on this type of prevention with standardized treatment processes, and the results can be pretty remarkable. For example, by monitoring patients who have just received chemotherapy and by treating those who develop symptoms the same day in the office, a cancer group is able to reduce emergency room visits and hospitalizations of cancer patients by more than 50 percent. Keeping patients with chronic illnesses healthy can really pay off. Over the next decade every medical group will develop, implement, and refine care processes that keep chronically sick patients healthier so as to reduce their use of healthcare services, especially the emergency room and hospital.

The next area to focus for cost control will be mental health. It turns out that mental health problems are actually among the leading drivers of healthcare costs. Mental health disorders are more widespread than we think. Approximately one-quarter of adults experience one or more disorders. More importantly, about 6 percent of adults suffer from seriously debilitating mental illness. Some of this relates to complex patients with schizophrenia and bipolar disorders whose care is not well coordinated, whose chronic medications are expensive, and whose institutionalizations for exacerbations can be prolonged. But a lot of this relates to patients with chronic illnesses who become depressed or anxious because of their health problems and whose depression then exacerbates their other illnesses because they fail to consistently take their medications or exercise or adhere to some other health program. Isolated and depressed patients use the healthcare system because it offers attention and meaningful social interactions. Patients with mental health issues are expensive.

Currently, the healthcare system responds poorly to these patients. It is estimated that only about a third of people with mental health problems receive treatment, and only about a third of those — 12 percent overall — are actually receiving adequate treatment. Why? Primary care physicians usually do not like dealing with mental health issues. So they refer patients to psychiatrists. But getting a new patient appointment with a psychiatrist, especially for patients who have Medicare or who have no or inadequate insurance, can take two or three months. By that time the patient may have gone to the emergency room a few times and been admitted to the hospital.
Besides, these patients need more than just the care of a psychiatrist; they need to be connected to social services, engaged in social activities that replace the meaningful but expensive attention they receive from nurses.
Today, the most advanced systems are experimenting with interventions. The next big area for improving quality of care and reducing costs will be routinely integrating standardized mental health interventions into primary care practice. Then, over the next decade, the 2020s, patients’ mental health problems will be taken seriously and seriously addressed by the mainstream. Mental health parity with physical health will finally happen — not because any legislature mandates it but because health systems find it necessary to improve quality and reduce total healthcare costs.

To read the entire article, pick up the September/October 2015 issue of The Saturday Evening Post on newsstands or …

Purchase the digital edition for your iPad, Nook, or Android tablet:

To purchase a subscription to the print edition of The Saturday Evening Post:

]]>http://www.saturdayeveningpost.com/2015/08/31/in-the-magazine/health-in-the-magazine/6-megatrends-healthcare.html/feed0Why Won’t Your Dentist Take Health Insurance?http://www.saturdayeveningpost.com/2015/08/31/in-the-magazine/wont-dentist-take-health-insurance.html
http://www.saturdayeveningpost.com/2015/08/31/in-the-magazine/wont-dentist-take-health-insurance.html#respondWed, 30 Nov -0001 00:00:00 +0000http://www.saturdayeveningpost.com/?p=110567Since the beginning of time, dentistry and medicine have been considered inherently distinct practices. But as we learn more about how diseases that start in our mouths can ravage the rest of our bodies, it's a separation that's increasingly hard to rationalize

]]>Kira Adam was tired of waiting. When she first noticed the cavity about six months ago, she tried to book a dentist’s appointment in College Park, Maryland, where she lives, but she had trouble finding a practice that would take her Medicaid insurance. “Every time I tried to schedule it, it was a two to three month wait” for an appointment, she told me.

The cavity got worse. When she finally did get seen, the dentist told her she would need a root canal. It would cost $1,000, and her insurance would pay nothing.

“He told me to come back when I had the money,” she said. As a baker at Panera Bread, she knew it would be a while before she did. She applied for and received a loan through CareCredit, a medical financing company, but it was a few hundred dollars short. So she waited some more — and tried to ignore the pain that was now shooting through her jaw.

On September 5, 2014, the wait was over. Or at least, most of it was. She was sitting in the stands of the Xfinity Center at the University of Maryland (UMD) and looking down on the basketball court, where rows and rows of people were tipped back in dental chairs, getting their teeth fixed as part of a large dental charity event. Adam works at night, so her husband stood in line outside the building from 11 p.m. to 7 a.m. to secure her spot. Adam drove over straight from work, taking the orange bracelet from her husband’s wrist. The bracelet meant she was in.

It was sad how necessary the Mission of Mercy dental clinic turned out to be. A sign outside at 11 that morning announced that the day-long event was full and could not accept more patients.

Inside, just beyond the double-doors graced with a Fear the Turtle banner, a reference to the university’s mascot, what unfolded was the opposite of a typical American dental visit, with its gentle small-talk and freebie toothbrushes. Here, tired-looking patients sat clustered in groups behind black cloth dividers, their dentists racing by with barely enough time to look up. A seemingly disoriented woman ambled toward me, her mouth stuffed with bloody gauze.

Under the bright gym lights, the patients were nearly elbow to elbow as their doctors worked. The event saw 1,200 patients, up from 700 in 2013. Not everyone could be seen on Friday; about 1,000 were turned away and told to try again the next day.
A tiny 3D printer stamped out new, fake teeth as their future owners waited nearby. In the middle of it all, a choir sang hymns on an elevated stage, lending the whole thing the air of a Greek tragedy.

In the stands, hundreds of people sat waiting their turn. Like Adam, most had been there since the wee hours. The longest line of all was for endodontic services, such as root canals, which can cost thousands and are not covered by Maryland’s Medicaid program.

James Hart drove up from Waldorf, 35 miles away, for a root canal that he has needed for three months. A clinic referred him here after quoting him $1,300.

Rochelle Hernandez, from Laurel, also needed a root canal. She had tried to sign up for dental insurance, but after paying a few other bills, she couldn’t afford the premium. Two weeks ago, she was able to get a dentist to take X-rays of the offending molar by using a discount coupon. But when that office told her it would be $2,000 to fix the problem, she knew she’d be headed to the UMD clinic instead.

Several other people waved me away when I approached them, saying they didn’t feel like talking. I probably wouldn’t have, either, if my teeth were hurting and my only hope of stopping the pain was a day-long wait and a very public drilling.

About a third of people in the U.S. don’t visit the dentist every year, and more than 800,000 annual ER visits arise from preventable dental problems. A fifth of Maryland residents have not visited a dentist in the past five years. Despite the fact that dental procedures are some of the most expensive office visits, dental coverage is treated like a garnish — the parsley of the insurance world.

“Medicaid doesn’t acknowledge that you have teeth unless you’re a child,” said Thomas Ritter, a dentist who was volunteering at the event.

One reason for this is that since the beginning of time, dentistry and medicine have been considered inherently distinct practices. The two have never been treated the same way by either the medical system or public insurance programs. But as we learn more about how diseases that start in our mouths can ravage the rest of our bodies, it’s a separation that’s increasingly hard to rationalize.

To read the entire article, pick up the September/October 2015 issue of The Saturday Evening Post on newsstands or …

Purchase the digital edition for your iPad, Nook, or Android tablet:

To purchase a subscription to the print edition of The Saturday Evening Post:

]]>Celebrating with far-flung relatives this holiday season? Take some time to gather information about your family’s health history. Here’s how.

Common diseases—heart problems, high blood pressure, and diabetes—and even some rare ones tend to run in families. But forewarned is forearmed. Knowing your health risks can help you recognize early warning signs and take action to keep you and your children well.

An online resource from the Office of the U.S. Surgeon General makes it easy to talk about and document the health problems of your parents, grandparents, and other blood relatives.

The information that you enter is protected under HIPAA (Health Insurance Portability and Accountability Act) and not available to the government or anyone else. To safely transfer the information to relatives, consider saving it to a CD or memory stick unless you have access to encrypted email.

]]>http://www.saturdayeveningpost.com/2014/04/17/health-and-family/medical-update/track-family-health-history.html/feed1The History of Health and Medicine in Americahttp://www.saturdayeveningpost.com/2014/04/17/history/post-perspective/history-health-medicine-america.html
Thu, 17 Apr 2014 13:44:22 +0000http://72.3.135.59/wordpress/?p=744As editor and publisher of The Saturday Evening Post magazine, Dr. Cory SerVaas brought a passion for health and prevention to the publication. A journalist and physician, Dr. Cory interviewed some of the world’s leading scientists, physicians, and researchers, translating complex material into easy-to-read and understand articles. You can read some of Dr. Cory fascinating […]

]]>As editor and publisher of The Saturday Evening Post magazine, Dr. Cory SerVaas brought a passion for health and prevention to the publication. A journalist and physician, Dr. Cory interviewed some of the world’s leading scientists, physicians, and researchers, translating complex material into easy-to-read and understand articles.

You can read some of Dr. Cory fascinating interviews from the pages of the magazine, beginning with the articles below:

]]>Hormone Therapy Is Backhttp://www.saturdayeveningpost.com/2013/05/07/in-the-magazine/health-in-the-magazine/hormone-therapy.html
Tue, 07 May 2013 12:00:54 +0000http://www.saturdayeveningpost.com/?p=84491Remember when all menopausal women were taking hormones, and then suddenly none were? Today, a new consensus is emerging that for some, the benefits of the treatment may very well outweigh the risks.

Today, some researchers are convinced that the widespread halting of hormone therapy in 2002 was an overreaction.

About five years ago, Sally Shepard, a 52-year-old human resources consultant from Santa Cruz, California, began experiencing hot flashes and especially heavy and irregular periods as part of perimenopause, the few years leading up to menopause. Shepard, who surfs, skis, golfs, and runs 20 miles a week, felt less motivated to stay active. But when Shepard asked about hormone therapy, her doctor discouraged her.

Throughout the ’90s, the pills and patches that delivered a combination of estrogen and progestin (a synthetic form of progesterone) were prescribed freely to menopausal women. By the end of that decade, an astounding 22 percent of women over 40 were being prescribed hormone therapy. It was considered a godsend, not just to ease the discomfort, but to ward off the risk of heart disease and brittle bones associated with menopause, not to mention the gloom and misery that sometimes accompanies “the change.”

But problems with hormone therapy arose in 2002 when a large clinical trial (the Women’s Health Initiative) sponsored by the National Institutes of Health was shut down after it became clear that taking the medication resulted in higher rates of stroke, heart disease, and breast and ovarian cancers. In a hastily assembled press conference in July 2002, the researchers shocked the world by announcing that the risks of taking the popular drugs outweighed the benefits. The news also came as a surprise to doctors, who had expected the trial to show hormone therapy protected women’s hearts. Droves of frightened menopausal women threw out their pills and hormone patches, leaving those with severe symptoms to endure the embarrassing hot flashes and sheet-drenching night sweats that disrupted their sleep and left them weary, dazed, and cranky.

“The pendulum had swung from hormone therapy is good for all women, to hormone therapy is bad for all women,” says Dr. JoAnn Manson, a WHI investigator and chief of preventive medicine at Brigham and Women’s Hospital in Boston, an affiliate of Harvard University. But it appears the pendulum is swinging again. Today, more than a decade after the WHI trial, a new consensus is emerging that, at least for younger women with moderate to severe menopausal symptoms, the benefits of short-term hormone therapy may outweigh the risks.

Related Stories From the Post:

Curious about hormone therapy? Follow these guidelines from the North American Menopause Society.

Shepard discovered the shift by doing some exploration of her own: “It didn’t seem those studies that had been so hyped in the news [back in 2002] were relevant to my circumstance.” She went back to her doctor, intent on reopening the discussion. To her surprise, this time her doctor was on board. “I don’t know if she had a change of heart … or if it took me being aggressive about it,” Shepard says. But, since she began hormone therapy, the hot flashes and abnormal bleeding are gone, and she has a lot more energy and what she can only describe as a “happiness factor.”

No one had predicted the outcome of the Women’s Health Initiative hormone studies. When they were first planned in 1992, they were designed as large, scientifically rigorous randomized trials to test whether hormone therapy could protect women from heart disease — something that had already been seen in smaller, less rigorous scientific studies.

So confident were scientists about the benefits of hormone therapy that the drugs were already widely prescribed not just to relieve symptoms of menopause, but to prevent heart disease. “Cardiologists were even starting women on the drugs in their 70s and 80s,” says Dr. Wulf Utian, founder of the North American Menopause Society and author of the 2011 book, Change Your Menopause: Why One Size Does Not Fit All. “There was a lot of wild use of hormones.”

The combination study was huge, involving more than 16,000 women aged 50 to 79, with most study volunteers at least a decade past menopause. (Significantly, the average age of study participants was 63.) The trial started in 1997 and was meant to be completed in 2005, but on May 31, 2002, a safety monitoring board found the number of breast cancers in women taking hormones exceeded a pre-specified limit and halted the study.

How bad was it? An initial analysis published in July 2002 in the Journal of the American Medical Association (JAMA)found women taking combination hormone therapy had a 41 percent higher risk of strokes, a 29 percent higher risk of heart attacks, and twice as many blood clots as women in the placebo group. (They also had a 37 percent lower risk of colon cancer and a 33 percent lower risk of having a hip fracture, but that information didn’t make the headlines.)

As frightening as these results sound when expressed as percentages, the actual risk to any individual woman was still quite low. In a press release about the results, WHI Acting Director Dr. Jacques Rossouw explained that over the course of a year, only 8 more out of 10,000 postmenopausal women with a uterus who took combination therapy would have an invasive breast cancer; 7 more would have a heart attack; 8 more would have a stroke; and 18 more would have blood clots compared with women not taking hormone therapy.

Still, WHI investigators took an all-or-nothing approach, and for the once hormone-happy medical community, the result was a major about-face. Sales of Prempro, the drug used in the combination estrogen and progestin study, fell nearly 50 percent in the first two years following the study.

Manson credits the WHI study with stopping the gross overuse of hormone therapy, especially in high-risk women long past menopause. But Utian argues that many younger women, who may have benefited from hormone treatments for menopausal symptoms, suffered. “What happened unfortunately is we went from gross overuse to gross under use,” he says. He believes the net effect of the WHI study may have been to harm more women than it helped. “Even now, it’s very difficult to get an internist to prescribe hormones.”

Research now suggests that starting hormone therapy well after menopause has more side effects than starting just at the time of menopause.

The North American Menopause Society’s (menopause.org) 2012 Position Statement on Hormone Therapy (HT) provides the following guidelines:

• HT remains the most effective treatment available for menopausal symptoms, including hot flashes and night sweats that can interrupt sleep and impair quality of life. Many women can take it safely.

• If you have had blood clots, heart disease, stroke, or breast cancer, it may not be in your best interest to take HT. Be sure to discuss your health conditions with your healthcare provider.

• How long you should take HT depends on whether you take estrogen alone or a combination of estrogen and progesterone. For combination therapy, the time is limited by the increased risk of breast cancer that is seen with more than three to five years of use. For estrogen alone, no sign of an increased risk of breast cancer was seen during an average of seven years of treatment, a finding that allows more choice in how long you choose to use estrogen therapy.

• Most healthy women below age 60 will have no increase in the risk of heart disease with HT. The risks of stroke and blood clots in the lungs are increased but, in these younger age groups, the risks are less than 1 in every 1,000 women per year taking HT.

• Estrogen therapy delivered through the skin (by patch, cream, gel, or spray) and low dose oral estrogen may have lower risks of blood clots and stroke than standard doses of oral estrogen, but all the evidence is not yet available.

Experts agree that a daily 1,500 mg dose of glucosamine sulfate is generally safe and well tolerated—the main exception being for pregnant and nursing mothers. Some studies show benefits in reducing joint pain and improving function, while others have failed to show any value. Stick with national brands when selecting a product, and make sure you’re buying glucosamine sulfate, rather than glucosamine hydrochloride. (The latter formula needs more clinical testing.)

As always, ask your doctor or pharmacist about potential interactions with prescription medicines before starting any new supplement.

Studies show that starving oneself causes changes in the brain that can lead to the inability to see oneself objectively. It’s “distorted body image,” according to Cleveland Clinic eating disorders specialist Ellen Rome, M.D., M.P.H.

Women suffering from anorexia, for example, tend to draw their silhouettes or estimate their hip width disproportionately larger than they actually are. This is not a coy way of denying their condition; when confronted with the truth, they will firmly deny their true size. Altered perceptions of body image are predictable and painful—but they are often reversible, says Rome.

For help, turn first to a medical doctor who is well-versed in eating disorders. Contact the National Eating Disorders Association (nationaleatingdisorders.org, 800-931-2237) for local specialists.

]]>Why We Need Germshttp://www.saturdayeveningpost.com/2013/02/26/in-the-magazine/health-in-the-magazine/good-bacteria.html
Tue, 26 Feb 2013 10:00:40 +0000http://www.saturdayeveningpost.com/?p=82145In the modern effort to eradicate disease, we pop antibiotics like candy, apply hand sanitizers with abandon, and gargle mouthwash by the gallon. But this carpet-bombing of germs takes a huge toll on good microbes as well as bad.

We are vastly, ridiculously, hopelessly, humblingly outnumbered: For every one human cell, there are an estimated 10 single-cell microbes in us or on us, at least 100 trillion in all, nestled in our guts and in our urogenital tracts, lying on our skin and happily ensconced in our mouths and noses—entire civilizations of fungi and protozoa and (mostly) bacteria that eat and breathe, evolve and reproduce and die.

Before you reach in horror for the hand sanitizer or industrial-strength mouthwash, you might want to keep something in mind. A profusion of research in just the past five years is showing that our microbial hitchhikers, collectively called the “human microbiota” and so small they account for only 1 or 2 percent of our weight, play a key role in maintaining our health. And we disrupt them at our peril. “It’s not possible to understand human health and disease without exploring the massive community of microorganisms we carry around with us,” says Professor George Weinstock of Washington University in St. Louis. Knowing which microbes live in healthy people “allows us to better investigate what goes awry in diseases that are thought to have a microbial link, like Crohn’s and obesity.”

The microbes in our body—especially some of the 10,000 or so species of bacteria in and on us—have indeed been implicated in disorders as diverse as obesity and Crohn’s, and also in asthma, heart disease, sinusitis, and possibly even mood disorders. They influence how big our appetite is and, possibly, even what foods we crave. They synthesize vitamins and affect how quickly we metabolize drugs such as acetaminophen (Tylenol), they protect against esophageal reflux and they churn out many of the same neurochemicals as our own brains. Given this job description, it’s hardly surprising that when perturbed, scientists are discovering, the microbiota can tip us into poor health or outright illness.

Related Stories From the Post:

In this video, Jonathan Eisen explains why good microbes may actually be our first line of defense against infection, disease, and lasting medical conditions.

Exactly how our bacterial companions affect our health is the subject of ongoing research in labs around the world, but one thing is clear: Our decades-long war on germs is looking seriously wrongheaded. In an effort to obliterate disease-causing microbes through antibiotics and anti-microbials—from the pills we down for a cold (against which antibiotics are useless) to the meat we eat to the hand-sanitizer-dispensers everywhere you look—we are carpet-bombing our microbiota. And that war on germs takes a huge toll on beneficial bugs, too.

One example: The bacterium Helicobacter pylori causes ulcers and has been linked to stomach cancers. Although it was once in almost everyone’s gut, it is now found in just 6 percent of U.S. children, Science magazine reported in 2011, probably due to the widespread use of antibiotics and anti-microbials. That should mean fewer ulcers, but there’s a dark lining to that silver cloud: H. pylori may ward off asthma. Scientists led by Dr. Martin Blaser of New York University Langone Medical Center found that those without H. pylori are more likely to have had childhood asthma than those with it. Coincidence? In 2011 scientists in Switzerland infected half of a colony of mice with the bacteria and left the other half germ-free. They showered all the mice with dust mites and other allergens. Mice with H. pylori were fine; those without suffered airway inflammation, the hallmark of asthma.

Exactly how H. pylori might ward off asthma is still a mystery, but researchers have made progress understanding the link between our microbiota and other diseases.

The field of microbiota and health took off in 2006, when scientists led by Jeffrey Gordon of Washington University in St. Louis noticed something: Fat mice and svelte mice have very different gut microbes. Could different microbes actually cause obesity? To find out, Gordon transferred gut bacteria called Firmicutes from obese mice into thin ones. The thin mice ate no more than they used to, but they quickly started packing on the pounds (okay, ounces). Firmicutes, it turns out, are really good at liberating calories from food, much better than the common gut bugs called Bacteroidetes. That finding offers a hint of why your friend can scarf down calories and remain slim while you have merely to walk past a bakery window to gain weight. “Some microbes change how efficiently we metabolize food,” says biologist Rob Knight of the University of Colorado, who studies the genetics of the microbiota, called the microbiome.

It seems Firmicutes are quite adept at digesting fats and carbs, allowing you to absorb many more of, say, the 1,200 calories in half of a Domino’s bacon-cheeseburger pizza than if you have fewer Firmicutes and more Bacteroidetes. “Obesity depends not just on calories ingested but also on the microbiome,” says Dr. Yang-Xin Fu of the University of Chicago Medicine. And, yes, like mice, obese people tend to have more Firmicutes and fewer Bacteroidetes than slim people.

At this point everyone asks, how can I get my slim friend’s menagerie of gut microbes? Short answer: Scientists don’t know yet. But they have some clues. For instance, Bacteroidetes—the microbes linked to slimness—proliferate in the presence of fructans, a form of fructose found in asparagus, artichokes, garlic, and onions, among other foods, notes microbiologist Andrew Gewirtz of Georgia State University. A diet high in fructans might support a good crop of slimming Bacteroidetes. On the other hand, he notes, stress decreases the abundance of Bacteroidetes, suggesting one more way stress causes obesity.

“Lots of people are exploring the possibility of using antibiotics or prebiotics or probiotics to treat obesity,” says Colorado’s Knight. Prebiotics are foods that promote the growth of some bacteria at the expense of others. Probiotics are live microorganisms such as the Lactobacillus in yogurt; the idea is to ingest beneficial ones. The strategy with antibiotics would be similar: Zap the obesity-promoting ones. These ideas are in their very earliest stages, so don’t go looking on your drugstore shelves for such products just yet.

Much clearer is the strong evidence that modern medicine’s penchant for antibiotics has a downside beyond the well-known problem of breeding antibiotic-resistant bugs. A study of 11,532 children found that, on average, those exposed to antibiotics for the usual childhood ills, such as ear infections, from birth to 5 months of age weighed more for their height than other kids. By 38 months, they had a 22 percent greater likelihood of being overweight, scientists reported last August. “The rise of obesity around the world is coincident with widespread antibiotic use,” says Blaser. “It is possible that early exposure to antibiotics primes children for obesity later in life.” That’s one reason farmers add antibiotics to animal feed: The drugs alter the gut bacteria in cattle, pigs, and others, substituting bacteria that are better at extracting maximum calories from feed and thereby making the animals pack on the pounds.

Sorry about the bad pun, but we’re talking about, um, fecal transplants. Recently published research in the New England Journal of Medicine shows that for a certain intransigient intestinal ailment, transplanting beneficial microorganisms from a healthy intestinal tract into an ailing one can work miracles.

In the study, fecal transplants quickly cured 15 of 16 people of a debilitating illness caused by a very nasty and stubborn bacteria called Clostridium difficile that antibiotics couldn’t cure. The results drive home the importance of maintaining a balanced and diverse microbiota.

For the transplant, donor feces were blended into a potion that was ported into the patient’s intestine via a tube down the throat. Some patients felt better within a day, and enrollment was halted early because the transplant group fared so much better than a control group.

“The study helps to scientifically prove the high success rates of fecal transplants that we see in our patients: This therapy works,” says Dr. Colleen R. Kelly, a gastroenterologist with the Women’s Medicine Collaborative in Providence, Rhode Island, who was not part of the original trial. As for the unpleasant-sounding methodology, pinpointing the curative strains may someday lead to therapeutic pills or products containing them.